Hydroxychloroquine appears to reduce the risk of thrombosis over the long term in patients who have systemic lupus erythematosus.
Combining hydroxychloroquine with aspirin long term in patients with lupus seems to further reduce the risk.
Cardiovascular disease and, in particular, accelerated atherosclerosis causes significant morbidity and mortality in patients with systemic lupus erythematosus, researchers noted. Prevention of cardiovascular disease through prophylaxis of clotting is a major focus of treatment in lupus, especially in patients who have antiphospholipid antibody, lupus anticoagulant, or isolated persistent anticardiolipin antibody positivity.
Low-dose aspirin and hydroxychloroquine currently are advocated for prevention of thrombosis, but study authors pointed out that when the protective effects start and how long they are sustained is not known.
No other long-term studies have looked at hydroxychloroquine and primary thromboprophylaxis in patients with systemic lupus erythematosus.
Serena Fasano and fellow researchers in Italy examined how cumulative doses of hydroxychloroquine alone and combined with aspirin affect thrombosis risk in patients with systemic lupus erythematosus and presented their findings in a recent Journal of Rheumatology article.
This retrospective observational cohort study enrolled 189 patients with systemic lupus erythematosus. Non-lethal thrombotic events occurred in 5.2% of subjects, including 1 stroke, 5 transient ischemic attacks, and 4 myocardial infarctions. No deaths were attributed to cardiovascular events in the study.
• 27.5% of subjects had been treated with high-dose steroids, which has been reported to contribute to atherosclerosis.
• 82% of subjects were prescribed hydroxychloroquine at 6 mg/kg; the median treatment period was 5 years.
No funding sources were disclosed.
Serena Fasano, Lucianna Pierro, Ilenia Pantano, et al. “Longterm Hydroxychloroquine Therapy and Low-dose Aspirin May Have an Additive Effectiveness in the Primary Prevention of Cardiovascular Events in Patients with Systemic Lupus Erythematosus.” J Rheumatol. 2017;44:1032-1038. doi: 10.3899/jrheum.161351. Epub 2017 May 15.